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A method of illustrating health statistics in peninsular Malaysia

Lau L

Med J Malaysia, 1974 Jun;28(4):234-8.
PMID: 4279021
Matched MeSH terms: Accidents/mortality; Infant Mortality
A short investigation of infantile mortality and child welfare on estates in Kedah

Cross B

Journal of the Malaya Branch of the British Medical Association, 1940;4:141-63.

Matched MeSH terms: Infant Mortality; Maternal Mortality; Mortality
Fulltext Perioperative mortality review in relation to pregnancy-related deaths

Achanna KS, Zaleha AM, Sachchithanantham, Farouk AM

Med J Malaysia, 2006 Aug;61(3):312-9.
PMID: 17240582 MyJurnal

Pregnancy-related deaths in four published perioperative mortality review reports were analysed. The aim is to look at the quality of surgical and anaesthetic services along with the perioperative care provided. The audit identified shortfalls in the logistic and support services and recommended remedial strategies. The review was conducted by a committee consisting of practising anaesthetists, surgeons and obstetricians who analysed the questionnaires collectively. A consensus was reached to categorise the death. There were 280 pregnancy-related deaths. Post-partum haemorrhage accounted for 31.8%, followed by hypertensive disorders of pregnancy (20.0% obstetric embolism (16.1%), sepsis (10.7%) and associated medical conditions (21.4%). In brief, there were comings in preoperative, intra-operative and post-operative care in some of the cases. Increased consultant input, clinical audit, improvements in monitoring and expansion of critical care facilities were the integral issues recommended.

Matched MeSH terms: Maternal Mortality*; Pregnancy Complications/mortality
Fulltext Deaths following acute diarrhoeal diseases among hospitalised infants in Kuala Lumpur

Lee WS, Ooi TL

Med J Malaysia, 1999 Sep;54(3):303-9.
PMID: 11045055

The risk factors and modes of death following acute diarrhoeal illness in children admitted to University Hospital, Kuala Lumpur between 1982 and 1997 were studied retrospectively. Among 4,689 cases of acute gastroenteritis admitted, ten deaths were noted. The case mortality rate was 2.1/1000 admissions. All deaths were infants below one year, with eight females and two males. Acute renal failure and acute pulmonary oedema were common preceding events. Female sex, infants less than twelve months, the presence of hyper or hyponatraemia and moderate to severe dehydration on admission were risk factors for deaths.

Matched MeSH terms: Diarrhea/mortality*; Hospital Mortality*
Mortality trends of young children in developing countries

Rutstein SO

IPPF Med Bull, 1983 Dec;17(6):2-4.
PMID: 12279694
Matched MeSH terms: Infant Mortality*; Mortality*
Mortality in SLE nephritis

Suleiman AB, Morad Z, Tong CT

Ann Acad Med Singap, 1987 Jan;16(1):175-8.
PMID: 3496037

In a review of 112 patients with SLE nephritis treated between 1976 and 1982, 31 were known to have died. Renal failure (32.2%) was the commonest cause of death. Gastrointestinal haemorrhage (16%), infections (12.8%) and central nervous system involvement (6.5%) were important causes of death. Thirteen out of 17 patients dying in the presence of renal failure had initially presented with renal impairment. Renal biopsies in 16 patients who have died showed diffuse proliferative glomerulonephritis in all except 1 patient, and uraemia was the commonest cause of death in these patients. Pregnancies terminating in abortions were followed by complications in 5 patients. Discontinuation of steroid therapy by patients was followed by complications, and ended in death in 6 patients.

Matched MeSH terms: Gastrointestinal Hemorrhage/mortality; Lupus Nephritis/mortality*; Uremia/mortality
Mortality in hyaline membrane disease

Sivanesan S

Med J Malaysia, 1973 Mar;27(3):207-10.
PMID: 4268926
Matched MeSH terms: Hyaline Membrane Disease/mortality*; Infant Mortality*
Fulltext Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, et al.

Nature, 2019 Oct;574(7778):353-358.
PMID: 31619795 DOI: 10.1038/s41586-019-1545-0

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Matched MeSH terms: Infant Mortality/trends*; Child Mortality/trends*
Fulltext Risk of anaesthesia--a review

Tan I, Delilkan AE

Med J Malaysia, 1993 Dec;48(4):381-91.
PMID: 8183160

Modern anaesthesia carries a definite although small risk. The risk from general and regional anaesthesia is reviewed, the causes explored, and preventive strategies discussed. Although anaesthesia may never be 100% safe, a knowledge of the risk and causes enables us to work towards this goal.

Matched MeSH terms: Anesthesia/mortality
Infant mortality in rural Malaysia: an analysis and their causes (1970-1984)

Yadav H

J Trop Pediatr, 1986 10;32(5):244-8.
PMID: 3795334 DOI: 10.1093/tropej/32.5.244
Matched MeSH terms: Infant Mortality*
Autopsy examination of firearm fatalities

Subramaniam S

Malays J Pathol, 1991 Jun;13(1):5-15.
PMID: 1795562

As general pathologists in Malaysia are required to perform medico-legal autopsies, this paper is written with the hope that it may serve as a guide to the less initiated. An account of elementary ballistics is included because it is essential for understanding the features of wounds produced by firearms. A complete autopsy examination including a systematic approach to the injuries is advocated. The recognition and interpretation of firearm injuries can often be difficult and it is essential that all features of injuries and other relevant findings are carefully observed and recorded. Relevant observations, documentation and opinions necessary for accurate determination of the true circumstances of death are discussed.

Matched MeSH terms: Wounds, Gunshot/mortality*
The epidemiological approach to atherosclerosis

Elliot O

Med J Malaya, 1972 Dec;27(2):95-102.
PMID: 4268046
Matched MeSH terms: Arteriosclerosis/mortality
Fulltext Investing in Maternal Health: Learning from Malaysia and Sri Lanka

Pathmanathan I, Liljestrand J, Martins JM, Rajapaksa LC, Lissner C, de Silva A, et al.

DOI: 10.1596/0-8213-5362-4 ISBN: 0-8213-5362-4

Citation: Pathmanathan I, Liljestrand J, Martins JM, Rajapaksa LC, Lissner C, de Silva A, et al. Investing in Maternal Health: Learning from Malaysia and Sri Lanka. Washington, DC: World Bank Publications; 2003.

The difference between maternal mortality in the industrialized and developing world is greater than any other development indicator. The apparent lack of progress in this area has generated a sense of hopelessness. Malaysia and Sri Lanka are two of the very few developing countries that have succeeded in reducing maternal mortality to levels comparable to many industrialized countries. This study provides the first comprehensive, in-depth analysis of the factors that contributed to maternal mortality decline in Malaysia and Sri Lanka over the last 50-60 years. It considers policy issues, health system developments, health system expenditures in maternal health, and the use in both countries, of professionally trained midwives.

Matched MeSH terms: Maternal Mortality; Mortality
Reflections on the maternal mortality millennium goal

Lawson GW, Keirse MJ

Birth, 2013 Jun;40(2):96-102.
PMID: 24635463 DOI: 10.1111/birt.12041

Nearly every 2 minutes, somewhere in the world, a woman dies because of complications of pregnancy and childbirth. Every such death is an overwhelming catastrophe for everyone confronted with it. Most deaths occur in developing countries, especially in Africa and southern Asia, but a significant number also occur in the developed world.

Matched MeSH terms: Abortion, Induced/mortality; Postpartum Hemorrhage/mortality; Obstetric Labor Complications/mortality; Maternal Mortality/trends*; Pregnancy Complications/mortality*; Puerperal Infection/mortality; Sepsis/mortality; Hypertension, Pregnancy-Induced/mortality
Health trends in three Asian countries--Ceylon, Malaysia and Singapore

Arumanayagam P, San SJ

Int J Epidemiol, 1972;1(2):101-9.
PMID: 4204766
Matched MeSH terms: Cardiovascular Diseases/mortality; Infant Mortality; Maternal Mortality; Mortality; Neoplasms/mortality; Parasitic Diseases/mortality
Fulltext Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study

Muller DC, Murphy N, Johansson M, Ferrari P, Tsilidis KK, Boutron-Ruault MC, et al.

BMC Med, 2016 Jun 14;14:87.
PMID: 27296932 DOI: 10.1186/s12916-016-0630-6

BACKGROUND: Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking, hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death.
METHODS: We analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between 40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years were calculated based on the fitted models.
RESULTS: We identified 11,930 deaths which occurred before the age of 70. The AF for premature mortality for smoking was 31 % (95 % confidence interval (CI), 31-32 %) and 14 % (95 % CI, 12-16 %) for poor diet. Important contributions were also observed for overweight and obesity measured by waist-hip ratio (10 %; 95 % CI, 8-12 %) and high blood pressure (9 %; 95 % CI, 7-11 %). AFs for physical inactivity and excessive alcohol intake were 7 % and 4 %, respectively. Collectively, the AF for all six risk factors was 57 % (95 % CI, 55-59 %), being 35 % (95 % CI, 32-37 %) among never smokers and 74 % (95 % CI, 73-75 %) among current smokers.
CONCLUSIONS: While smoking remains the predominant risk factor for premature death in Europe, poor diet, overweight and obesity, hypertension, physical inactivity, and excessive alcohol consumption also contribute substantially. Any attempt to minimise premature deaths will ultimately require all six factors to be addressed.

Matched MeSH terms: Alcohol Drinking/mortality; Hypertension/mortality; Obesity/mortality; Smoking/mortality; Mortality, Premature*
Fulltext Maternal deaths due to liver disease in Malaysia

Ravindran J, Jayadev R, Lachmanan SR, Merican I

Med J Malaysia, 2000 Jun;55(2):209-19.
PMID: 19839149

Liver disease is an important and serious condition in pregnancy. The Confidential Enquiries Into Maternal Deaths in Malaysia showed that there were 23 maternal deaths attributed to liver disease between 1991-1994. Over the same period, there were 1066 reported maternal deaths with 929 of them being due to direct and indirect causes. Thus 2.15% of such deaths were due to liver disease in Malaysia. The three main causes of maternal deaths due to liver disease in pregnancy were hepatitis (6 cases), acute fatty liver in pregnancy (6 cases) and septicaemia (4 cases). Liver disease is common at a mean of thirty weeks of gestation with a preponderance to women of low parity. Only two patients in this series had no antenatal care. The majority of cases (45.8%) presented between 28-37 weeks of gestation. All cases delivered by spontaneous vaginal delivery. Remediable factors that were identified included failure to appreciate the severity of disease. Case summaries of all the cases of maternal deaths due to liver disease are discussed and a guideline to management of liver disease in pregnancy presented.

Matched MeSH terms: Liver Diseases/mortality*; Maternal Mortality/ethnology; Maternal Mortality/trends*
Maternal mortality in University Hospital Kuala Lumpur, Malaysia

Kong H, Sinnathuray TA, Ng KH

Med J Malaysia, 1974 Jun;28(4):226-8.
PMID: 4278955
Matched MeSH terms: Abortion, Septic/mortality; Eclampsia/mortality; Maternal Mortality*
Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study

Dagenais GR, Leong DP, Rangarajan S, Lanas F, Lopez-Jaramillo P, Gupta R, et al.

Lancet, 2020 03 07;395(10226):785-794.
PMID: 31492501 DOI: 10.1016/S0140-6736(19)32007-0

BACKGROUND: To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches.
METHODS: The PURE study is a prospective, population-based cohort study of individuals aged 35-70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years.
FINDINGS: This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5-10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs.
INTERPRETATION: Among adults aged 35-70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care.
FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).

Matched MeSH terms: Cardiovascular Diseases/mortality*; Mortality/trends; Neoplasms/mortality*
Fulltext Shock Index: A Simple and Effective Clinical Adjunct in Predicting 60-Day Mortality in Advanced Cancer Patients at the Emergency Department

Cheng TH, Sie YD, Hsu KH, Goh ZNL, Chien CY, Chen HY, et al.

Int J Environ Res Public Health, 2020 07 07;17(13).
PMID: 32646021 DOI: 10.3390/ijerph17134904

Deciding between palliative and overly aggressive therapies for advanced cancer patients who present to the emergency department (ED) with acute issues requires a prediction of their short-term survival. Various scoring systems have previously been studied in hospices or intensive care units, though they are unsuitable for use in the ED. We aim to examine the use of a shock index (SI) in predicting the 60-day survival of advanced cancer patients presenting to the ED. Identified high-risk patients and their families can then be counseled accordingly. Three hundred and five advanced cancer patients who presented to the EDs of three tertiary hospitals were recruited, and their data retrospectively analyzed. Relevant data regarding medical history and clinical presentation were extracted, and respective shock indices calculated. Multivariate logistic regression analyses were performed. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of the SI. Nonsurvivors within 60 days had significantly lower body temperatures and blood pressure, as well as higher pulse rates, respiratory rates, and SI. Each 0.1 SI increment had an odds ratio of 1.39 with respect to 60-day mortality. The area under the ROC curve was 0.7511. At the optimal cut-off point of 0.94, the SI had 81.38% sensitivity and 73.11% accuracy. This makes the SI an ideal evaluation tool for rapidly predicting the 60-day mortality risk of advanced cancer patients presenting to the ED. Identified patients can be counseled accordingly, and they can be assisted in making informed decisions on the appropriate treatment goals reflective of their prognoses.

Matched MeSH terms: Nasopharyngeal Neoplasms/mortality*; Shock/mortality*; Hospital Mortality*

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